Intro To RadTech: Status of health care delivery Flashcards Preview

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Flashcards in Intro To RadTech: Status of health care delivery Deck (9)
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1
Q

What does HMO stand for?

A

Health maintenance organization

2
Q

What is capitation?

A
  • prepayment for services on a per-member per-month basis
  • physician or group receives specific amount regardless of how much care the patient needs
  • the effect: less exams, procedures, tests ordered - less cost to the insurance company
3
Q

What is fee-for-service?

A
  • method in which health care providers receive a fee for services performed
  • individual fees…not “bundled” (as opposed to prepaid services)
  • the holder makes all health care decisions independently
  • patient (or insurance company) pays physician directly
  • results in more tests and procedures ordered
4
Q

What is Managed Care?

A
  • any arrangement for health care where there is an intermediate between the person seeking care and the physician
  • who is the “manager”?- the insurance company

Characteristics:
Variety of techniques designed to reduce “unnecessary costs” through
• economic incentives to physicians
• review of medical necessity of services
• controls on inpatient admissions/length of stay
• selective contracting with H.C. Providers
• intensive management of high-cost care cases

5
Q

What is a PPO?

A

Preferred Provider Organization

• Patients choose from a finite list of doctors who have agreed to limit their fees(Co-pays apply’ deductible can apply)

I patients can go “out of network” for a higher out-of-pocket fee

6
Q

What is DRG?

A

Diagnosis-related groups

• 1983- federal government changed reimbursement for Medicare and Medicaid patients

  • 467 categories of admitting diagnosis

Is there a conflict of interest in using DRG’s?

Cost-Containment measures. What effect on quality of care?
•ratio part-time vs. full-time personnel changes
•healthcare workers may need to have more than one place of employment
•reduction in number of people having “benefited” positions
•short-staffing
•burnout

Effect when shortage of qualified radiologic technologists
• work load increased
• stress increased
•use of “travelers”
•wage increased
•use of incentives- sign on bonus, e.g…

7
Q

What does ICG stand for?

A

International Classification of Diseases

8
Q

What is RIS?

A

Radiology Information System

9
Q

What is the CMA?

A

California Medical Association